Result of percutaneous nephrolithotomy operation in solitary kidney patients

Objective: Comparison between patients with solitary and non-solitary kidney for percutaneous nephrolithotomy. Patients and Methods: The data of solitary kidney (Group 1) and non-solitary kidney (Group 2) patients who applied to Dicle University Medical Faculty Urology Clinic between March 2013-June 2019 and who underwent PNL operation were retrospectively analyzed. Age, stone size, hydronephrosis status, renal parenchymal thickness, DJS application, scopy duration, clavien complication rating, postoperative stone-free rates were compared. Patients with HT, DM, cardiac patology, <18 years of age and anatomic disorders were excluded from the study. Result: 121 patients in Group 1 and 320 patients in Group 2 were included in the study. There were 75 males and 46 females in Group 1 and 190 males and 130 females in Group 2. The mean age of the patients was 43.9 ± 16.6 years in Group 1 and 41 ± 13.5 years in Group 2. When measuring the stone dimensions, the longest axis of the stones was taken into consideration. The mean size was 31.7 ± 12.3 MM and 30.8 ± 10.8 MM. The mean parenchymal thickness was 23.7 ± 5.6 MM in solitary kidneys and 14.7 ± 3.3 MM in normal kidneys, and there was a statistically significant difference (p <0,01). Operative times were 71.6 ± 25.5 min. in Group 1 and 66 ± 22.3 min. in Group 2, and were longer in patients with solitary kidneys (p = 0.021). There was no significant difference between the length of hospital stay in both groups (p = 0.840). Postoperative first month CT scans revealed complete stone-free in 99 patients (%82) in Group 1 and 252 patients (%79) in Group 2, but there was no significant difference between the two groups (p=0,477). DJ was performed in 3 patients in Group 1 and 7 patients in Group 2 after wetting continued for 24 hours after removal of nephrostomy catheter (p=0,855).. Complications were seen in 41 patients (%33,8) in Group 1 and 81 patients (%25.3) in Group 2. According to the Modified Clavien Scale (MCS), 16 patients had Grade 1, 15 patients had Grade 2, 5 patients had Grade 3a, 4 patients had Grade 3b and 1 patient had Grade 4 complications. Grade 4 complications were segmental v renal vein injuries. According to the Modified Clavien Scala in Group 2, 23 patients had grade 1, 33 patients had grade 2, 15 patients had grade 3a, 9 patients had grade 3b and 1 patient had grade 4 complications. Grade 4 complications were colon injuries. Both groups were similar in terms of complications (p = 0.073). Of the 121 patients with solitary kidney, 98 (%81) underwent PNL and 23 (%19) underwent UMPNL. There was no statistically significant difference between postoperative stone-free (p=520) and complication types (P=412) and UM-PNL was found to be effective and safe in patients with solitary kidneys. Conclusion: PNL can be used effectively and safely in patients with solitary kidneys. Keywords: Solitary kidney, Percutaneous nephrolithotomy, Nephrolithiasis